This week I talk about a feasibility cohort study which sought to determine whether a larger cohort study addressing this question would be feasible. Listen to hear some interesting preliminary findings. 

Merza, E.Y., Pearson, S.J., Mallows, A.J. and Malliaras, P., 2023. The relationship between psychological, cognitive, and contextual factors and rehabilitation outcomes in Achilles tendinopathy: A prospective feasibility cohort study. Physical Therapy in Sport.

Mallows, A., Jackson, J., Littlewood, C. and Debenham, J., 2020. The association of working alliance, outcome expectation, adherence and self‐efficacy with clinical outcomes for Achilles tendinopathy: A feasibility cohort study (the MAP study). Musculoskeletal Care, 18(2), pp.169-176.

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We have known for a while that type of exercise intervention (e.g. intensity, frequency, etc) does not seem to influence self-reported outcomes such as pain. Maybe all the benefits from exercise are explained by non-specific effects, or maybe exercise has benefits that do not depend on the type of exercise.

In this episode, I discuss 3 studies that look into (at least partly) other benefits that we may see at the level of the muscle and tendon from higher-load exercise interventions. 

References:

Radovanović, G., Kunz, J., Bohm, S., Arampatzis, A. and Legerlotz, K., 2021. Reliable and effective novel home-based training set-up for application of an evidence-based high-loading stimulus to improve triceps surae function. Journal of Sports Sciences, 39(24), pp.2786-2795.

Radovanović, G., Bohm, S., Peper, K.K., Arampatzis, A. and Legerlotz, K., 2022. Evidence-Based High-Loading Tendon Exercise for 12 Weeks Leads to Increased Tendon Stiffness and Cross-Sectional Area in Achilles Tendinopathy: A Controlled Clinical Trial. Sports Medicine-Open, 8(1), pp.1-19.

Radovanović, G., Bohm, S., Arampatzis, A. and Legerlotz, K., 2023. In Achilles Tendinopathy the Symptomatic Tendon Differs from the Asymptomatic Tendon While Exercise Therapy Has Little Effect on Asymmetries—An Ancillary Analysis of Data from a Controlled Clinical Trial. Journal of Clinical Medicine, 12(3),

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In this episode, I am discussing kinesiophobia in the context of tendon rehab and how rehab can be conceptualised as graded exposure for some people. 

References

1) Physiotherapy management of Achilles tendinopathy

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In this episode, I talk about load test pain assessment and how this can also be used to assess kinesiophobia and movement apprehension. 

References

1) Physiotherapy management of Achilles tendinopathy: https://pubmed.ncbi.nlm.nih.gov/36274038/

2) Kinesiophobia Severity Categories and Clinically Meaningful Symptom Change in Persons With Achilles Tendinopathy in a Cross-Sectional Study: Implications for Assessment and Willingness to Exercise: https://pubmed.ncbi.nlm.nih.gov/35295417/

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Sit beside a gently cracking fire on a cold Winter's night. Hear the logs splitting as they burn. We'll add the wood to keep the fire toasty.

Original recording.

auscastnetwork.com

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We set up a microphone in an old tin shed during a rain storm.

Sit back, relax and enjoy.

auscastnetwork.com.au

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Fall asleep by a forest stream.

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30-minute meditation ambience to help you get to sleep.

#sleep #meditation #Zen #relax #calm #yoga #reiki  

Royalty free.

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This is an interesting study from the Delaware tendinopathy group among others investigating a host of structural, tissue property, functional and pain factors that may persist among people with Achilles tendinopathy making a return to running. Provides guidance to clinicians about potential impairments to consider assessing. 

Here's the link to the study:

Corrigan, P., Hornsby, S., Pohlig, R.T., Willy, R.W., Cortes, D.H. and Silbernagel, K.G., 2022. Tendon loading in runners with Achilles tendinopathy: Relations to pain, structure, and function during return‐to‐sport. Scandinavian Journal of Medicine & Science in Sports.

Here's the link to my upcoming course series in the UK in Sept:

https://www.eventbrite.com/cc/mastering-lower-limb-tendinopathy-uk-sept-2022-670009

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In this episode I talk about three qualitative studies that aim to understand the patient perspective and patient motivations in Achilles tendinopathy. I find this work really helps clinicians to understand what patients are gong through so we are able to be empathic and help them. Hope you enjoy!

Here's a link to courses in the UK:

https://www.eventbrite.com/cc/mastering-lower-limb-tendinopathy-uk-sept-2022-670009

Here are the studies:

Turner, J., Malliaras, P., Goulis, J. and Mc Auliffe, S., 2020. “It's disappointing and it's pretty frustrating, because it feels like it's something that will never go away.” A qualitative study exploring individuals’ beliefs and experiences of Achilles tendinopathy. PloS one, 15(5), p.e0233459.

Mc Auliffe, S., Synott, A., Casey, H., Mc Creesh, K., Purtill, H. and O'Sullivan, K., 2017. Beyond the tendon: experiences and perceptions of people with persistent Achilles tendinopathy. Musculoskeletal Science and Practice, 29, pp.108-114.

Mallows, A., Head, J., Goom, T., Malliaras, P., O'Neill, S. and Smith, B., 2021. Patient perspectives on participation in exercise-based rehabilitation for Achilles tendinopathy: A qualitative study. Musculoskeletal Science and Practice, 56, p.102450.

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This paper is more than 30 years old but it is a beauty. Farley et al talk about human preferred hopping frequency and how it relates to metabolic cost and how fast muscles are contracting, and also how our instructions can influence how well people hop (and the mechanisms that drive this). Important to consider hopping instruction when assessing submaximal hopping in the clinic. 

Here's a link to the paper

Farley, C.T., Blickhan, R., Saito, J. and Taylor, C.R., 1991. Hopping frequency in humans: a test of how springs set stride frequency in bouncing gaits. Journal of applied physiology, 71(6), pp.2127-2132.

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There is so much debate about the use of steroids for tendinopathy. Opinions vary between 'you should never use steroid as will lead to recurrence, worse pain or rupture' to 'it's fine, do as much steroid as you like'. Opinions dominate as we have limited data. Until now. This is the first trial looking at 2 year outcome for exercise +/- steroid for Achilles tendinopathy. Interesting findings!

Here's the link to the study:

Johannsen, F., Olesen, J.L., Øhlenschläger, T.F., Lundgaard-Nielsen, M., Cullum, C.K., Jakobsen, A.S., Rathleff, M.S., Magnusson, P.S. and Kjær, M., 2022. Effect of Ultrasonography-Guided Corticosteroid Injection vs Placebo Added to Exercise Therapy for Achilles Tendinopathy: A Randomized Clinical Trial. JAMA Network Open, 5(7), pp.e2219661-e2219661.

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This week, I had an engaging conversation with Anthony Nasser, an up-and-coming researcher on tendinopathy who recently completed his PhD on proximal hamstring tendinopathy. Our discussion covered the reasons for the lack of research attention towards this condition, the current state of evidence, and insights from his doctoral studies. You can find the full conversation here.

Here are Anthony's related publications:

Nasser, A.M., Pizzari, T., Grimaldi, A., Vicenzino, B., Rio, E. and Semciw, A.I., 2021. Proximal hamstring tendinopathy; expert physiotherapists’ perspectives on diagnosis, management and prevention. Physical Therapy in Sport, 48, pp.67-75.

Nasser, A.M., Vicenzino, B., Grimaldi, A., Anderson, J. and Semciw, A.I., 2021. Proximal hamstring tendinopathy: a systematic review of interventions. International journal of sports physical therapy, 16(2), p.288.

Nasser, A., Semciw, A., Grimaldi, A., Rio, E., Pizzari, T. and Vicenzino, B., 2022. Core outcome set development for proximal hamstring tendinopathy (COS-PHT): a study protocol. Physical Therapy Reviews, 27(4), pp.313-319.

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This is a new and lovely to read randomised trial comparing pain science education (including lots of good biopsychosocial info) versus placebo education for Achilles tendinopathy. Some interesting findings and potential avenues for further study. Definitely worth a listen and read. 

Here is a link to the actual paper: 

https://journals.lww.com/pain/Abstract/9900/The_effects_of_pain_science_education_plus.122.aspx

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This is a new study from my PhD student, Igor Sancho. He looks at strength, psychological and other factors that may be different between health runners and runners with Achilles tendinopathy. Seated calf raise 6RM seems to be the strongest predictor of having Achilles tendinopathy. Some interesting other findings and clinical implications. 

Here is a link to this paper, and Igor's other PhD papers:

• Sancho, I., Morrissey, D., Willy, R.W., Tayfur, A., Lascurain-Aguirrebeña, I., Barton, C. and Malliaras, P., 2022. Recreational runners with Achilles tendinopathy have clinically detectable impairments: A case-control study. Physical Therapy in Sport, 55, pp.241-247.
• Sancho, I., Malliaras, P., Barton, C., Willy, R.W. and Morrissey, D., 2019. Biomechanical alterations in individuals with Achilles tendinopathy during running and hopping: A systematic review with meta-analysis. Gait & posture, 73, pp.189-201.
• Sancho, I., Morrissey, D., Willy, R.W., Barton, C. and Malliaras, P., 2019. Education and exercise supplemented by a pain-guided hopping intervention for male recreational runners with midportion Achilles tendinopathy: a single cohort feasibility study. Physical Therapy in Sport, 40, pp.107-116.

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On this episode I focus on a new study from my PhD student Eman Merza. It is a cross-over randomised trial testing the effect of high and low contraction time and high and low intensity isometric contractions on acute changes to tendon volume and stiffness. Some very interesting potential insights for tendon adaptation. Good work, Eman!

Hope you enjoy. 

Peter

Here is a link to the study (open access for a few weeks): 

https://journals.biologists.com/jeb/article/225/10/jeb243741/275395

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Had a lovely chat with Shawn Hanlon who is a PhD candidate about his relatively new paper exploring patient features and clinical characteristics and how they may define certain subgroups of Achilles tendinopathy . Lots more to learn in this field and this is early work, but we discuss some of the juicy potential clinical implications.

Hope you enjoy!

And here is the link to the paper and also the 

1/ Hanlon, S.L., Pohlig, R.T. and Silbernagel, K.G., 2021. Beyond the diagnosis: Using patient characteristics and domains of tendon health to identify latent subgroups of Achilles tendinopathy. journal of orthopaedic & sports physical therapy, 51(9), pp.440-448.

2/ And this is the bumper issue of JOSPT from 2015 that is all about tendinopathy: journal of orthopaedic & sports physical therapy, 45(11) 

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There is lots of debate about the pain mechanisms, particularly if there are central changes, in Achilles and other tendinopathies. Most studies in the literature use proxy measures of central sensitisation like pressure pain threshold away from the painful site, Other measures like conditioned pain modulation have been investigated less frequently. In this episode of talking tendons I discuss a huge new study investigating CPM in Achilles tendinopathy with some interesting findings and implications.

Hope you enjoy!

Here is the link to the study:

Mkumbuzi, N.S., Mafu, T.S., September, A.V., Posthumus, M. and Collins, M., 2021. Conditioned pain modulation is not altered in recreational athletes with Achilles tendinopathy. Translational Sports Medicine, 4(1), pp.147-153.

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This is one of my favourite narrative expert reviews that discusses the benefits of human biologic springs like the Achilles tendon. These benefits can be summarised as follows: 

• Metabolic energy conservation
• Amplification of muscle power output
• Attenuation of muscle power input

Some really interesting mechanisms and insights for rehabilitation . I hope you enjoy!

Here is the link to the study:

Roberts, T.J. and Azizi, E., 2011. Flexible mechanisms: the diverse roles of biological springs in vertebrate movement. Journal of experimental biology, 214(3), pp.353-361.

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I had a great time talking Gluteal tendinopathy with Chris Clifford. Chris is an experienced clinician from Glasgow who is in the throws of completing his PhD on this condition. We chatted about rehab, the use of isometrics, difficult patient groups and how to navigate them, and much more. 

I hope you enjoy!

Here is 2 related publications from Chris' PhD: 

1/ Clifford, C., Paul, L., Syme, G. and Millar, N.L., 2019. Isometric versus isotonic exercise for greater trochanteric pain syndrome: a randomised controlled pilot study. BMJ open sport & exercise medicine, 5(1), p.e000558.

2/ Clifford, C., Challoumas, D., Paul, L., Syme, G. and Millar, N.L., 2020. Effectiveness of isometric exercise in the management of tendinopathy: a systematic review and meta-analysis of randomised trials. BMJ open sport & exercise medicine, 6(1), p.e000760.

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Patients often ask about dietary supplements and if they may be helpful in recovering from a tendinopathy problem. There is a new systematic review out which has attempted to answer this question and it is the subject of this episode of talking tendons.

I hope you enjoy. 

Here is the reference

Qiu, F., Li, J. and Legerlotz, K., 2022. Does Additional Dietary Supplementation Improve Physiotherapeutic Treatment Outcome in Tendinopathy? A Systematic Review and Meta-Analysis. Journal of clinical medicine, 11(6), p.1666.

And links to upcoming Mastering Lower Limb Tendinopathy course in Australia

https://www.eventbrite.com/cc/mastering-lower-limb-tendinopathy-live-australia-211689

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Will midportion Achilles pain improve if you wait and see? This is often a really important question to discuss with patients. Luckily we have some evidence to answer it which I explore in this short podcast (9 minutes). Hope you enjoy. 

Here are the related studies

1/ Horstmann, T., Jud, H.M., Fröhlich, V., Mündermann, A. and Grau, S., 2013. Whole-body vibration versus eccentric training or a wait-and-see approach for chronic Achilles tendinopathy: a randomized clinical trial. journal of orthopaedic & sports physical therapy, 43(11), pp.794-803.

2/ Rompe, J.D., Nafe, B., Furia, J.P. and Maffulli, N., 2007. Eccentric loading, shock-wave treatment, or a wait-and-see policy for tendinopathy of the main body of tendo Achillis: a randomized controlled trial. The American journal of sports medicine, 35(3), pp.374-383.

3/ de Vos, R.J., van der Vlist, A.C., Zwerver, J., Meuffels, D.E., Smithuis, F., van Ingen, R., van der Giesen, F., Visser, E., Balemans, A., Pols, M. and Veen, N., 2021. Dutch multidisciplinary guideline on Achilles tendinopathy. British journal of sports medicine, 55(20), pp.1125-1134.

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Here is my recent chat with Dr Ruth Chimenti about Achilles tendinopathy

We touched on some interesting topics, including

• Kinesiophobia and whether it changes with treatment
• Pain education for tendinopathy - what should it involve? does it work?
• Patient centred rehabilitation

Here is a link to some brand new trial data from Ruth's lab - she tested efficacy of pain education which is novel for Achilles tendinopathy.

https://clinicaltrials.gov/ct2/show/study/NCT04059146

And here is a link to the protocol paper:

https://pubmed.ncbi.nlm.nih.gov/33141102/

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Palpation can be useful for the diagnosis and assessment of tendinopathy, but there are limits. This is because non-painful tendons can be tender, and tenderness in painful tendons seems to be very slow to get better. 

Link to Evidence for Improvement in Local but not Diffuse Pressure Pain Thresholds Following Physical Therapist Interventions for Tendinopathy: A Systematic Review

Link to  Reproducibility and clinical utility of tendon palpation to detect patellar tendinopathy in young basketball players

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Sara Campbell Lambert is passionate about young children coping with trauma. She experienced the bush fires in Bega NSW and witnessed the effect it had on the local kids, To that end, she has organized a concert staring Ginger the Frog, who has her own issues but overcomes them with the help of others. If you would like to attend the concert go to www.gingerthefrog.com/show 

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DREW WHENAN HAS TURNED HIS LIFE AROUND AND NOW MAKES A DIFFERENCE BY INTERVIEWING OTHERS WHO ARE ALSO ON THE RECOVERY TRAIL. DREW INTERVIEWED ME IN LATE JUNE 2021 ON THE EVE OF MY TWO YEAR ANNIVERSARY FOR BEING DRUG AND ALCOHOL FREE. YOU CAN SEE MORE OF DREW'S INTERVIEW ON HIS YOUTUBE CHANNEL "THE RECOVERY PROJECT""

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‘Fool Me Twice’ is a podcast about diamonds. Jules and Zara were approached by a woman in Hong Kong who owns a diamond business, and had an incredibly compelling story to tell, full of twists and turns. Hearing her story, Zara became interested in diamonds themselves, and started doing some digging. This podcast follows the story of that scam, and attempts to unravel some of the shadier aspects of the diamond industry as a whole. We interview people related to the scam, a diamond miner, scam experts and individuals with their own personal diamond stories. This 8-episode true crime podcast will have you on the edge of your seat.

COMING SOON:  Available on Auscast Network and all podcast platforms in July 2021.

Apple Podcasts: https://apple.co/36kbNmH

Spotify: https://spoti.fi/3gBgOdR

Auscast Network: https://www.auscastnetwork.com/home/fool-me-twice

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In this episode I talk about a new systematic review on plantarflexor muscle impairments in Achilles tendinopathy. It is clear that the relationship is not as clear as what you might think, and there are also some very interesting insights to how plantarflexor dysfunctions may change following rehabilitation.

Link to paper

Are Plantarflexor Muscle Impairments Present Among Individuals with Achilles Tendinopathy and Do They Change with Exercise? A Systematic Review with Meta-analysis

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Natures lullaby to guide you to a deep sleep.

Why does the sound of rain and thunder help sleep?

According to the University of Melbourne, Rain sounds is a rhythmic ticking sound, which sounds like a wonderful lullaby that can help people fall asleep quickly.

Studies have found that when rain sounds enters people’s brain, brain unconsciously relaxes and produces alpha waves, which are very close to the state of brain when human sleeps.

Rain sound is generally between 0 and 20 kHz. It is not upsetting. On the contrary, this sound makes people comfortable. However, if there is a sudden sound of thunder in the middle of rain sounds, it will make people stressful. At the same time, the level of cortisol in people’s body will be high.

Enjoy your new-found better sleep. :)

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Natures lullaby to guide you to a deep sleep.

Why does the sound of rain and thunder help sleep?

According to the University of Melbourne, Rain sounds is a rhythmic ticking sound, which sounds like a wonderful lullaby that can help people fall asleep quickly.

Studies have found that when rain sounds enters people’s brain, brain unconsciously relaxes and produces alpha waves, which are very close to the state of brain when human sleeps.

Rain sound is generally between 0 and 20 kHz. It is not upsetting. On the contrary, this sound makes people comfortable. However, if there is a sudden sound of thunder in the middle of rain sounds, it will make people stressful. At the same time, the level of cortisol in people’s body will be high.

See omnystudio.com/listener for privacy information.

How does white noise benefit sleep?

1. Helps you build a bedtime ritual.
   Especially if you have trouble falling asleep, but even if you don’t, it’s a good idea to establish a routine before bed (both for children and adults).  Make sleep hygiene a habit!
   
   
2. Keeps your bedroom QUIET.
   For optimal sleep, you need the optimal sleep environment.  White noise buffers disturbing sounds and creates a quiet cocoon, regardless of your surroundings or sleep situation.
   
   
3. Shuts down your busy brain.
   Ever have trouble falling asleep because your To-Do list won’t stop buzzing, or personal worries keep you awake? White noise can help - it’s even shown to help ease symptoms of anxiety. There’s a reason some people use it to meditate!
   
   
4. Once you’re asleep, you’ll stay asleep.
   By masking sounds that might interrupt your sleep, white noise protects your peaceful slumber.  And if you DO wake up, it’s often easier to fall back asleep.
   
   
5. You’ll sleep more soundly.
   You may not realize how many times you wake up each night.  But even if you don’t remember it in the morning, those little interruptions affect the quality of your sleep.  So give white noise a try and see if you don’t wake up feeling more refreshed.
   
   
6. You can bring white noise anywhere.
   While you can’t count on your environment, you CAN manage the noise factor, if you’ve got a sound machine. And many are compact and portable, making them easy to throw into a suitcase, diaper bag, or handbag. (This one’s especially helpful when traveling. Hotel room doors slamming and noisy hallways, anyone?)

(Info via yogasleep.com)

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Feeling down due to an upsetting event in your life? This guided meditation will help you through it. 

Voiced by Andy Martin

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Need to build focus? This is the perfect guided meditation for you. 

Voiced by Andy Martin

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Set yourself free with this guided meditation.
Voiced by Andy Martin

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Interesting perspective paper from Arampatzis et al talking about how we should consider tuning of muscle tendon unit in terms of muscle strength and tendon stiffness when considering training for specific groups. 

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The perfect way to prepare for bedtime...

Voiced by Andy Martin

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A 5 minute Meditation for Children with Anxiety or anyone that needs some kind words after a difficult time. 

Voiced by Andy Martin

(https://www.facebook.com/AndyMartinau)

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A short and simple meditation for Mental Clarity.

Spoken by Andy Martin

(https://www.facebook.com/AndyMartinau)

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1 Hour of Empowering and Inspiring Yoga, Meditation, & Relaxation Music

(Music is Copyright free)

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12 minutes of Deep Sleeping Music.

(Music is copyright free)

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Take a few minutes to chill and relax in preparation for a sound sleep.

Horizon - Nomyn (Copyright free)

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Music to relax your mind for better sleep.

Music is copyright free. 

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10 minutes of chilltime before bed to help the ease of sleep.

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A 3 minute sleep song by Scott Buckley (no copyright) to help you relax.

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Spoke to the the delightful and extremely talented Fiona O'loughlin on FiveAA. The internationally acclaimed comedian is known for her brilliant on stage performances but also for her battle with the booze. She speaks to me without reserve. There are many many lessons within this personal and sometimes uncomfortable interview. 

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This talking tendons episode will discuss a study by Igor Sancho, PhD, assessing Achilles forces during common rehab exercises and habitual activities and how this relates to reported pain among runners. Some interesting implications for practice.

Achilles tendon forces and pain during common rehabilitation exercises in male runners with Achilles tendinopathy. A laboratory study

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This high quality trial provides further evidence to shift us away from eccentric training for Patelar Tendinoapthy.

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My next guest on The Mental Health Show is Fang. Fang teaches the ancient art of a Tai Chi Here business is called "Meridian Connection", and I had the please of observing one of her classes recently. Fang spoke to me recently about how she came to be a Tai Chi teacher and the benefits the practice provides.

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I recently had the pleasure of speaking with Cate Howell who's a GP, therapist, educator and author. Her latest book A Changing Man is all about men's mental health. Cate wrote the book with her son and various teaching activities, Alex Barnard who's musician with a postgraduate degree in psychology.

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My guest this time around on The Mental Health Show is Stephen Coard. Stephen is a former homeless man. But now, not only does he have a place to live, he also greets Adelaide commuters with a sign which promotes SMILING. PLEASE ENJOY.

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